Transurethral resection of the prostate (TURP) is the primary modality to alleviate bladder outflow obstruction secondary to benign enlargement of the prostate gland. However, this procedure has several potential complications including life threatening dilutional hyponatremia from the absorption of hypotonic irrigating media such as water, glycine or sorbitol. The absorptive hyponatremia is attributed to several surgical occurrences including perforation of the prostatic capsule, fenestration of a vascular sinus or a prolonged resection time.
On the other hand, utilization of the preferred irrigating media, physiologic 0.9 N saline, for an endoscopic resection using a standard monopolar energy source is not feasible because a substantial portion of the radiofrequency energy source to the resectoscope (from a electrosurgical generator) is dissipated within the ionic nature of the sodium chloride. Thus, use of monopolar energy has fallen out of favor with most endoscopic surgeons, whether they are attempting to perform urologic, gynecologic, arthroscopic or laparoscopic resections.
Sleeves for resectoscopes, which accommodate a bipolar energy source and which deliver the electrosurgical radiofrequency within a saline medium, are known in the art. However, the outer protective coating of these sleeves of these bipolar devices abuts the urethra. Although the outer protective coating of the sleeve potentially protects the urethra from the return electrode, any interruption in the continuous irrigation flow apparatus, whether inflow or outflow, causes a devastating thermal injury throughout the entire length of the male urethra. This type of injury requires extensive reconstructive surgery, urinary incontinence, sexual dysfunction or a combination thereof.